Emeline Lequy1,2, Emmanuel Wiernik3, Diane Cyr3, Rachel Nadif4,5, Cédric Lemogne6,7,8, Ramchandar Gomajee9, Marcel Goldberg3,7, Marie Zins3,7, Guillaume Airagnes3,4,7,10. 1. INSERM, UMS 011, Villejuif, France, e.lequy@gmail.com. 2. INSERM, U1168, VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France, e.lequy@gmail.com. 3. INSERM, UMS 011, Villejuif, France. 4. INSERM, U1168, VIMA, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France. 5. Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny-le-Bretonneux, France. 6. AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte et du sujet âgé, Paris, France. 7. Univ Paris Descartes, 12, rue de l'école de médecine, Paris, France. 8. Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France. 9. Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France. 10. AP-HP, Hôpitaux Universitaires Paris Ouest, Pôle Psychiatrie et Addictologie, Centre Ambulatoire d'Addictologie, Paris, France.
Abstract
BACKGROUND: Electronic cigarettes (e-cigarettes) have become increasingly popular, yet beyond social or technical features, the specific health-related reasons adults use e-cigarettes remain poorly understood. OBJECTIVE: To explore the cross-sectional associations between perceived health and current e-cigarette use in a large population-based cohort. METHODS: From the participants included in the French CONSTANCES cohort (a large general-purpose national population-based cohort) from 2015 to 2017, we included 18,300 ever tobacco smokers with data on their e-cigarette use. We used logistic regressions to estimate the associations between e-cigarette use and perceived health (global and respiratory), stratifying on participants' smoking status and adjusting for sociodemographic characteristics. To examine the role of objective health features (reported diagnoses and measured parameters during a health examination), we adjusted for prior history of respiratory and cardiovascular diseases, diabetes, cancer, spirometry, and blood pressure. Finally, we examined the effect of additionally adjusting for several health-related behaviors. RESULTS: Participants with poor perceived health (global and respiratory) were at greater risk of e-cigarette use. These associations remained unchanged after adjustment for objective health features and health-related behaviors (e.g., in current smokers, for global perceived health, an odds ratio of 1.10 [95% CI 1.03-1.16] per increase on an 8-point scale from very good to very poor). CONCLUSIONS: Our findings suggest that the more current and former smokers felt unhealthy, the more they tended to currently use e-cigarettes. People who regularly use e-cigarettes should obtain medical supervision that takes into account not only objective diagnoses and measurements but also perceived health. Counseling practices could include assessing perceived health status to reinforce motivation to quit smoking.
BACKGROUND: Electronic cigarettes (e-cigarettes) have become increasingly popular, yet beyond social or technical features, the specific health-related reasons adults use e-cigarettes remain poorly understood. OBJECTIVE: To explore the cross-sectional associations between perceived health and current e-cigarette use in a large population-based cohort. METHODS: From the participants included in the French CONSTANCES cohort (a large general-purpose national population-based cohort) from 2015 to 2017, we included 18,300 ever tobacco smokers with data on their e-cigarette use. We used logistic regressions to estimate the associations between e-cigarette use and perceived health (global and respiratory), stratifying on participants' smoking status and adjusting for sociodemographic characteristics. To examine the role of objective health features (reported diagnoses and measured parameters during a health examination), we adjusted for prior history of respiratory and cardiovascular diseases, diabetes, cancer, spirometry, and blood pressure. Finally, we examined the effect of additionally adjusting for several health-related behaviors. RESULTS:Participants with poor perceived health (global and respiratory) were at greater risk of e-cigarette use. These associations remained unchanged after adjustment for objective health features and health-related behaviors (e.g., in current smokers, for global perceived health, an odds ratio of 1.10 [95% CI 1.03-1.16] per increase on an 8-point scale from very good to very poor). CONCLUSIONS: Our findings suggest that the more current and former smokers felt unhealthy, the more they tended to currently use e-cigarettes. People who regularly use e-cigarettes should obtain medical supervision that takes into account not only objective diagnoses and measurements but also perceived health. Counseling practices could include assessing perceived health status to reinforce motivation to quit smoking.